Provider Demographics
NPI:1508439159
Name:KING, MITCHEL J (MS, LMCHA, NCC)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:MS, LMCHA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7582 HAPPY HILL RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9053
Mailing Address - Country:US
Mailing Address - Phone:336-904-5782
Mailing Address - Fax:
Practice Address - Street 1:235 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5305
Practice Address - Country:US
Practice Address - Phone:336-794-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health